Adherence to and Effectiveness of Positive Airway Pressure Therapy in Children With Obstructive Sleep Apnea

Study Objectives: Obstructive sleep apnea (OSA) is a common pediatric condition characterized by recurrent partial or complete cessation of airflow during sleep, typically due to inadequate upper airway patency. Continuous positive airway pressure (CPAP) is a therapeutic option that reduces morbidity. Despite efforts to promote use, CPAP adherence is poor in both pediatric and adult populations. We sought to determine whether demographics, insurance status, OSA severity, therapeutic pressure, or comorbid conditions were associated with pediatric CPAP adherence. Methods: A retrospective review of adherence download data was performed on all pediatric patients with initiation or adjustment of CPAP treatment over a one-year period with documented in-laboratory CPAP titration. Patients were grouped as CPAP adherent or non-adherent, where adherence was defined as > 70% nightly use and average usage ≥ 4 hours per night. Differences between the groups were analyzed by χ 2 test. Results: Overall, nearly half of participants were CPAP adherent (49%, 69/140). Of the demographic data collected (age, ethnicity, sex, insurance status), only female sex was associated with better adherence (60.9% vs 39.5% of males adherent; odds ratio [OR] = 2.41, 95%CI = 1.20-4.85; p = 0.01). Severity of OSA (diagnostic apnea-hypopnea index [AHI] and degree of hypoxemia), therapeutic pressure, and residual AHI did not impact CPAP adherence (p > 0.05). Patients with developmental delay (DD) were more likely to be adherent with CPAP than those without a DD diagnosis (OR = 2.55, 95%CI = 1.27-5.13; p = 0.007). Female patients with trisomy 21 tended to be more adherent, but this did not reach significance or account for the overall increased adherence associated with female sex. Conclusions: Our study demonstrates that adherence to CPAP therapy is poor but suggests that female sex and developmental delay are associated with better adherence. These findings support efforts to understand the pathophysiology of and to develop adherence-promoting and alternative interventions for pediatric OSA.

Section: Introductionmentioning

confidence: 99%

Correlates of Pediatric CPAP Adherence

Hawkins

Jensen

Simon

et al. 2016

“…[9][10][11][12] CPAP adherence patterns of adolescents have not been extensively studied, but studies of medication adherence in other adolescent groups, such as asthmatics, epileptics, and diabetics have demonstrated poor adherence. 13,14 Poor adherence in adolescents may be related to not understanding or not perceiving the benefi ts of the treatment, wanting to conform to peers, and rebelling against authority.…”

mentioning

confidence: 99%

Investigating Reasons for CPAP Adherence in Adolescents: A Qualitative Approach

Prashad

Marcus

Maggs

et al. 2013

Self Cite

adolescents and their caregivers. To our knowledge, this is the fi rst study focused on the adolescent age group.The purpose of the study was to identify and explore factors that infl uenced adolescent CPAP use, using a modifi ed grounded theory approach.16 Grounded theory is a qualitative method that seeks to generate theories from the data, to offer explanations for the phenomenon being explored. METHODSThis exploratory study consisted of qualitative semi-structured interviews and a download of the adolescent's adherence data from his or her CPAP machine during the previous month.Study Objectives: Adolescents with obstructive sleep apnea syndrome (OSAS) represent an important but understudied subgroup of long-term continuous positive airway pressure (CPAP) users. The purpose of this qualitative study was to identify factors related to adherence from the perspective of adolescents and their caregivers.Methods: Individual open-ended, semi-structured interviews were conducted with adolescents (n = 21) and caregivers (n = 20). Objective adherence data from the adolescents' CPAP machines during the previous month was obtained. Adolescents with different adherence levels and their caregivers were asked their views on CPAP. Using a modifi ed grounded theory approach, we identifi ed themes and developed theories that explained the adolescents' adherence patterns. Results: Adolescent participants (n = 21) were aged 12-18 years, predominantly male (n = 15), African American (n = 16), users of CPAP for at least one month. Caregivers were mainly mothers (n = 17). Seven adolescents had high use (mean use 381 ± 80 min per night), 7 had low use (mean use 30 ± 24 min per night), and 7 had no use during the month prior to being interviewed. Degree of structure in the home, social reactions, mode of communication among family members, and perception of benefi ts were issues that played a role in CPAP adherence. Conclusions: Understanding the adolescent and family experience of using CPAP may be key to increasing adolescent CPAP adherence. As a result of our fi ndings, we speculate that health education, peer support groups, and developmentally appropriate individualized support strategies may be important in promoting adherence. Future studies should examine these theories of CPAP adherence. S C I E N T I F I C I N V E S T I G A T I O N SO bstructive sleep apnea syndrome (OSAS) affects approximately 2% of children and adolescents.1 OSAS in children may result in severe complications if left untreated, such as growth failure, pulmonary hypertension, neurocognitive defi cits, behavioral problems, and attention defi cit hyperactivity disorder. [2][3][4][5][6] In young children, OSAS can often be treated with adenotonsillectomy. However, in adolescents, adenotonsillectomy may not be effective, as adenoids and tonsils involute with age 7,8 and obesity is more likely to be present. While weight loss may be an effective treatment for OSAS in this age group, it is difficult to achieve and maintain, particularly for those with severe o...

“…Although the overall PAP adherence in our sample was very low, it was similar to other pediatric centers. [7][8][9] The observed high risk for poor adherence to PAP therapy confirms why the American Academy of Pediatrics clinical practice guideline for evaluation and management of OSA in children does not recommend PAP therapy as a reliable first-line therapy for OSA in children when adenotonsillectomy is an option. 1 In addition, we also observed that adherence for the whole group declined with time.…”

Section: Discussionmentioning

confidence: 99%

“…1 PAP is a very effective therapy, but poor adherence to therapy is a limiting factor, with most studies showing a high dropout rates in up to one-third of children and low average nightly use, often less than one-half of their expected sleep period for age. [7][8][9] Usage of the device can be uncomfortable for children, disruptive to the family lifestyle, and requires parental supervision and support. Recent studies have shown better neurobehavioral outcomes in children who are adherent to PAP therapy.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Positive Airway Pressure Adherence in Obstructive Sleep Apnea Enhanced by Family Member Positive Airway Pressure Usage

Puri

Ross

Mehra

et al. 2016

Study Objectives: Adherence to positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) remains a challenge in children. We hypothesized that the presence of another family member on PAP therapy (parent, sibling, other family member) would be associated with better adherence in the child. Methods: We conducted a retrospective chart review to identify children < 18 years of age who had a new diagnosis of OSA between Jan 2011 and May 2013. Outcomes were objective PAP adherence at 1 week, 1 month, and 3 months. Potential predictors included family member on PAP therapy, patient demographics, and clinical characteristics. Group differences between children with and without a family member on PAP therapy were determined using χ 2 test and Wilcoxon two-sample test. PAP adherence measures at each time point and patterns of change across time between the two groups were examined using mixed-effects models. Results: The final analytic sample included 56 children: age 13.2 ± 3.7 years, 60% male, 67% African American, 65% obese, and 32% with developmental disabilities. The mean obstructive apnea-hypopnea index was 25.2 ± 28.7, and 19 (33%) had a family member on PAP therapy. Overall PAP adherence was 2.8 ± 2.4 h/night at 3 months. At month 3, the group with a family member on PAP therapy had significantly greater average nightly PAP use on all nights (3.6 ± 0.6 vs. 2.3 ± 0.39) and on nights used (4.8 ± 0.6 vs. 3.8 ± 0.40); (p value = 0.04). Conclusions: Overall PAP adherence was low, but having a family member on PAP therapy as a "role model" was associated with better adherence. Commentary: A commentary on this article appears in this issue on page 941. Keywords: positive airway pressure (PAP), adherence, obstructive sleep apnea, adherence, children Citation: Puri P, Ross KR, Mehra R, Spilsbury JC, Li H, Levers-Landis CE, Rosen CL. Pediatric positive airway pressure adherence in obstructive sleep apnea enhanced by family member positive airway pressure usage. J Clin Sleep Med 2016;12(7):959-963.